The overall purpose of this project is to explore the subjective factors associated with health care utilization by individuals 65 years and over. Previous research suggests that the disproportionate high use of health care by older people may be associated not only with manifest medical needs, but also by latent psychosocial needs. However, before designing a large-scale systematic study of this problem, preliminary research is needed which explores phenomenologically the patients' reports of both the manifest medical functions and the latent social functions they derive from health services. A sample of 100 older patients will be drawn from the regular users of a primary care medical clinic. Each patient will receive a psychosocial and functional assessment, and their medical records will be examined to determine their utilization patterns during the previous year. In addition, in-depth open-ended interviews will center on the patients' discussion of their health status, the reasons and activities leading to the visit, their perceptions of the costs and benefits stemming from the visit, the socializing functions it provides, the perceived supportive functions of the clinic staff, and their level of satisfaction with the care they receive. Observations will also be made of the patients' behaviors and interactions with staff and other patients. A content analysis of the qualitative data will identify the major subjective factors relating to the visit. These will be coded and transferred to measures. These factors will be associated with objective measures on social network supports, health and functional status, and utilization patterns. Comparisons will be made between high users (more than the national average of 6.7 visits per year) and regular users. Through retesting and comparing the strength of these associations, the subjective factors patients associate with health care utilization will be identified. After objective medical needs are ruled out, findings will be used to design an instrument which can efficiently assess the extent the acute care system is used to fulfill latent psychosocial needs of the older outpatient.